In 2010, the Affordable Care Act (ACA) was passed by Congress and signed into law by President Obama. This legislation provided a number of important consumer protections provisions that we’re already in place in several states, Colorado included. Most of these provisions covered small group markets and the ACA extended them to the individual health insurance market. While many of these mandated provisions significantly improved access to individual insurance, their impact on expanding the number of people insured is quite modest. In fact, the ACA’s principal tool for extending health care has been the expansion of the Medicaid program to cover able-bodied working individuals, without dependent children, and by increasing the income eligibility up to 138% of the federal poverty level.

The ACA has expanded coverage through the Medicaid program, at an enormous cost to the taxpayers, but has otherwise failed to deliver on its promises to lower costs and to expand private insurance coverage. This is particularly true in the health insurance exchanges, where individuals are able to navigate these government-sponsored websites to see what options are available for them and the subsidies they are eligible for based on income. 

For those purchasing insurance through Colorado’s insurance exchange in 2017, they will find that rates have increased an average of 20% over 2016. Nationally, the price of insurance coverage has increased by 25%. Additionally, the number of insurers willing to provide coverage to individuals is rapidly dwindling in our state. In western Colorado, there are 14 counties where only 1 insurance carrier services their area. Clearly this model is unsustainable.

What I will plan to do to address the inevitable failure of the ACA in Congress is to:

• Reform the Medicaid program.
  • Key here is giving states more flexibility to design their own systems. This will not only improve outcomes but contain cost. 
  • Limit the Medicaid expansion to those now enrolled and allow them to stay on it so long as they continue to meet current eligibility requirements.
• Eliminate the employer mandate.
  • This mandate only applies to businesses of 50 or more employees while most of the problems associated with access to employer-based health insurance are found in smaller businesses which have avoided the mandate by not adding jobs.
  • Allow small business to band together to purchase their health insurance so that they can get the same discounts large businesses.
• Eliminate the individual mandate
  • In too many cases, it’s cheaper to pay the penalty and buy insurance only when it’s needed, thereby ‘gaming’ the system and pushing up rates for everyone else.
  • Replace this with a tighter requirement to maintain continuous coverage in order to retain eligibility for all the consumer protections (i.e. preexisting conditions) contained in the ACA.
• Provide incentives for the purchase of health insurance.
  • Give individuals the same tax deductibility that businesses have when they buy health insurance.
  • Use the tax code, to assist low income individuals, through the use refundable tax credits paid directly for the insurance plan of their choice.
  • Increasing the contribution limits for health saving accounts.
• Maintain the consumer protections contained in the ACA.
  • Requiring insurance carriers to cover preexisting conditions;
  • Prohibiting lifetime caps;
  • No price discrimination on the basis of gender; and
  • Allow dependents to stay on their parents’ policies until age 26.

Finally and perhaps most importantly, I will not vote for to repeal any part of the ACA without a concurrent replacement.